I am in a state where NP practice was modernized a few years back. No more collaborative requirement for those with a relatively small amount of experience.
Having lived for many years under the old rule, I can tell you that a very quick look at a small fraction of NP records every 3 months, as previously required, would not protect the public from an incompetent person.
So the old requirements were BS. And NPs are expected to know what is outside their scope, just like every other medical professional, and to refer.
That being said, we are now graduating people from such low quality programs that I truly fear for the profession.